Anand D, Stevenson CJ, West CR, Pharoah PO. Arch Dis Child. 2003;88:135–138
Purpose of the Study.
Very low birth weight (VLBW) infants (birth weight of <1500 g) are typically preterm and usually require respiratory support in the nursery, placing them at risk for lung injury, which might have long-term consequences. Do these children have reduced lung function and respiratory disease when they reach adolescence?
A cohort of 128 VLBW infants and 128 age- and gender-matched control subjects born in 1980 or 1981 were studied at 15 years of age.
A history of any respiratory support received during the neonatal period was determined from hospital records. Smoking habits and current respiratory morbidity were determined with questionnaires. Current pulmonary function was measured with a spirometer.
Comparing the VLBW and control groups, differences in the mean values for forced vital capacity (FVC) and forced expiratory volume in 1 second were not significant. However, even after adjustment for active or passive smoking, there were statistically significant differences between the VLBW and control groups in the mean values for forced expiratory flow between 25% and 75% of FVC (−12.42%, P < .001) and forced expiratory volume in 1 second/FVC ratio (−3.53%, P < .001). Respiratory symptoms were more common among the index cohort than the comparison group, including chronic cough (odds ratio: 3.05; 95% confidence interval [CI]: 1.28–7.44), wheezing (odds ratio: 2.78; 95% CI: 1.43–5.44), and asthma (odds ratio: 3.46; 95% CI: 1.41–8.79).
Adolescents of VLBW, compared with matched control subjects, showed obstruction of medium-sized and small airways. The index VLBW subjects, compared with the control subjects, were also more prone to chronic cough, wheezing, and asthma.
The decreases in lung function among VLBW infants appeared to affect primarily small airways, in a pattern suggesting obstruction. Although the absolute decrements were small, they were clinically significant, resulting in a threefold increase in asthma. This indicates another compelling reason to see that pregnancies proceed to term.